右肾周间隙上份源于脏器肿块CT表现特征探讨

目的：探讨右肾周间隙上份不同脏器来源肿块的CT表现特征。方法：观察和分析76例经手术，病理和临床证实，位于右肾周间隙上份，源于不同脏器，直径≥4cm肿块的增强扫描CT表现特征，结果：肿块直径＜8cm的22例中，其优势平面在肝门平面以上的3例均来源于肝脏，在肝门平面以下的19例中，18例（94．7％）来源于右肾上腺和右肾；下腔静脉肝内段（IVC－Ⅰ段）和肝门至右肾门平面段（IVC－Ⅱ段）同时向左前方推移多见于肝脏肿块（24／27，88．9％），IVC－Ⅱ段向前移的7例全为右肾上腺肿块；门静脉右支后移（3例）和门静脉癌栓（12例）全部见于肝脏肿瘤，造成某脏器实质缺损常为来源于该脏器的肿块，而脏器受压推移征则常为邻近脏器肿块推压所致；肾筋膜显示的33例中，11例位于肾筋膜囊外的肿块均来源于肝脏，而22例位于肾筋膜囊内的肿块来源于右肾上腺和右肾；13例侵犯右膈脚的恶性肿瘤中，9例（69．2％）来源于右肾上腺。结论：肿块优势平面的位置，对邻近大血管和脏器的影响，对右膈脚的侵犯以及与肾筋膜囊的关系等CT征象，均有助于鉴别其脏器来源。     

肾周间隙积液的CT表现及解剖学基础

目的:结合肾周间隙的解剖学基础分析肾周间隙积液的CT表现。材料和方法:观察59例肾周间隙积液的分布及CT表现。结果:肾周间隙积液CT表现:肾窦水肿,肾被膜下积液,肾周间隙内桥隔增厚,肾周间隙脂肪层内斑片状影,肾被膜及肾前、肾后筋膜增厚,部分同时有圆锥侧筋膜增厚肿胀。右侧肾周间隙积液向上可至肝裸区。结论:CT能够清楚显示肾周间隙积液和肾筋膜的分隔作用,了解这些解剖结构,可合理地解释影像学征象及了解疾病扩展途径,为泌尿外科及介入治疗提供依据。     

肝泡型包虫病的CT诊断

目的探讨肝泡型包虫病的CT表现特征和病理基础。方法全部19例包虫抗体间接血凝试验和血清酶联免疫吸附试验为阳性,部分病例并经病理活检证实。结果CT影像主要表现为形态不规则、边界不清、密度不均匀以低密度为主的混合密度影。几乎均伴有不同程度的钙化,钙化具有一定的特征性。增强扫描后密度无变化。CT影像分三型地图征型,假囊肿型及周边晕影型。结论CT不仅能发现肝泡型包虫病,并可显示各种合并症及转移。     

泡状棘球蚴病肝外转移的CT影像特点

目的 探讨肝外泡状棘球蚴病(AE)的CT诊断及鉴别诊断.资科与方法回顾性分析31例经手术或活检病理证实的肝外AE的CT表现. 结果肺AE 24例,CT表现为以肺野外带和肺底分布为主的单发或多发肿块结节,内见钙化灶、小空泡征或空洞;脑AE 17例,平扫呈均质实性肿块或实性肿块伴多发囊泡,增强扫描呈靶样环状强化,6例病灶周围显示小囊泡征;骨AE 4例,CT表现为溶骨性骨质破坏,内见结节样或小圈状钙化灶,病变突破骨皮质后形成软组织肿块;肾上腺AE 14例,CT表现为混杂密度肿块内多发的结节样钙化灶或小囊泡征;肾AE 2例;累及腹膜后和背部软组织AE 4例.结论 CT检查能够明确AE肝外转移部位和侵犯范围,其表现有一定特征,结合流行病史有助于诊断.     

肾周脂肪肉瘤1例

患者男,50岁。查体发现右肾上腺肿物1周就诊。无发热、腰痛、肉眼血尿、消瘦,饮食睡眠可,大小便正常。查体:腹平软,无压痛,肝脾肋下未触及,双肾区无叩击痛。实验室检查:无异常。影像学检查:①超声检查:右肾上腺区可见6.4cm×6·6cm实性低回声团,其内可见星点状彩色血流。超声提示:右肾上腺区占位性病变;②CT表现:右肾上方见软组织肿块,大小约8.0cm×6.8cm×6.6cm,形态不规则,边界较清晰,有分叶,肿块伸入右肾上极后方,略有包绕,右肾上极周围脂肪间隙密度增高,右肾上腺受压推挤至肝缘,肿块内密度不均匀,平扫CT值28HU,增强扫描后肿瘤轻度强…     

青海高原地区体部包虫病的CT表现

目的 分析青海高原地区体部包虫病的CT表现. 方法回顾性分析我院108例包虫病患者的CT资料,探讨其CT表现特点及诊断.结果 108例中,101例为囊型包虫病,7例为泡型包虫病.囊型包虫病中单纯型26例,内囊分隔型15例,多子囊型37例,实质钙化型19例,混合型11例.108例中,大多数为肝脏包虫,肺包虫7例,肺包虫合并心脏包虫1例,胫骨包虫合并感染1例,18例为肝脏合并腹腔内多器官、多部位包虫.本组资料显示腹、盆腔包虫发生率高于肺部. 结论 CT能够对体部包虫病定性和定位,其CT表现有一定特征,诊断并不困难.     

尿外渗和尿瘤的病因及影像学诊断价值

目的 :探讨尿外渗和尿瘤的病因及影像学诊断价值。方法 :回顾性分析20例尿外渗和尿瘤的病因及影像学表现。结果:20例中,单纯尿外渗17例,尿外渗合并尿瘤1例,单纯尿瘤2例。超声表现为肾被膜下及输尿管周围无回声区或腹膜后囊性无回声区。CT平扫表现为肾被膜下及输尿管周围液体积聚或腹膜后囊性肿块。CT增强扫描延迟期可见对比剂外渗。尿外渗常伴肾周间隙桥隔增厚、肾周间隙内脂肪层斑片状影、肾筋膜增厚及肾旁间隙积液。结论:超声及CT可清楚显示病变及梗阻原因,结合病史可诊断尿外渗和尿瘤。     

人体少见部位包虫病的CT表现

目的：探讨人体少见部位包虫病的CT表现及其诊断价值。方法：回顾性分析经CT诊断及手术病理证实的35例少见部位包虫病的CT表现。结果：所有病例均为囊型包虫病,腹腔包虫21例,心脏包虫1例,肾脏包虫4例,脾脏包虫5例,胫骨包虫1例,髂骨包虫3例,其中合并肝包虫19例、肺包虫4例。囊型包虫病在CT上因病程和病理的不同可表现为单囊型、多子囊型、钙化等;骨包虫CT表现为病骨呈类多房状膨胀性骨质破坏及周围包囊性病灶,内可见子囊及小碎骨片。结论：少见部位包虫病具有一定的特征性CT表现,结合临床流行病学特点可提高诊断准确率。     

肝细胞癌扩散至右肾上腺的CT表现及其解剖学基础

目的分析肝细胞癌(HCC)扩散至右肾上腺的CT增强表现特征，探讨扩散的途径和解剖学基础，为临床提供全面的影像学信息，帮助选择治疗方案。资料与方法经临床、病理证实的HCC连续性病例中，回顾性分析肿瘤扩散至右肾上腺患者39例，另选择临床确诊为HCC，但右肾上腺形态、密度无异常者5例作为对照组。全部病例均采用螺旋CT动、门脉双期增强扫描。重点观察病灶部位、大小、密度，肝裸区是否受侵犯，肝内病灶与右肾上腺之间的毗邻关系，右肾上腺形态、轮廓、密度，右肾上腺区域有无软组织密度肿块及其强化特征。结果39例肝内病灶经裸区侵犯右肾上腺，其中10例右肾上腺区未形成软组织肿块，但右肾上腺与肝内肿块分界不清、正常轮廓消失，动脉期其密度低于左肾上腺，门静脉期密度不均匀；29例右肾上腺区见软组织肿块或结节且与肝内肿块分界不清，右肾上腺正常轮廓消失或完全被肿块包埋。右肾上腺区肿块，CT增强扫描动脉期呈不均匀明显强化或轻度强化，门脉期密度降低，其强化时相及特征与肝内原发病灶一致。结论HCC可通过肝裸区直接侵犯右肾上腺。根据CT增强动、门脉双期扫描右肾上腺形态、密度有无异常及右肾上腺区软组织肿块密度、强化时相和特征，可判断HCC是否扩散至右肾上腺。     

急性胰腺炎侵及胃裸区的CT表现

目的 :探讨急性胰腺炎 (acutepancreatitis ,AP)胃裸区受累CT表现特征 ,与毗邻结构受累的关系。材料和方法 :对15 8例AP患者行螺旋CT增强或平扫 ,观察胃裸区受累CT表现特征和受累发生率 ,与毗邻结构受累的关系。结果 :胃裸区受累发生率为 75 .9% ,表现为小点条状、小斑片状到片团状软组织密度影或伴积液。胃裸区内病变向下直接与肾旁前间隙内的胰腺周围间隙相连续 ;向左、向上与左膈下潜在脂肪间隙相连续。结论 :AP时胃裸区易受累 ,表现为不同程度的炎性改变。胃裸区向下直接与肾旁前间隙内的胰腺周围间隙相通连 ;向左、向上与左膈下潜在脂肪间隙相通连。     

肝脏泡状棘球蚴病的多层螺旋CT影像特征

目的分析肝泡状棘球蚴病的多层螺旋CT（MSCT）表现特点，评价MSCT的诊断价值。方法26例病人全部进行MSCT检查，原始数据经过图像高级处理工作站行冠矢状面重建和血管成像处理，MSCT所见与手术病理结果行对照分析。结果26例共检出28个病灶，所有病例均表现为不均质的低密度肿块，平扫时界线欠清而增强后境界清楚；26例的主要影像学特征还包括病灶内出现数量不等的钙化（26／26）；中心液化坏死（20／26）；边缘区域的小囊泡征象（15／26）；病灶所在的肝脏边缘有收缩凹陷（12／26）和健叶代偿性肥大（18／26）。位于肝门区或者累及肝门的病灶伴有胆管扩张（9／26），脾肿大（12／26），腹水（1／26）。MSCT血管成像（MSCTA）显示24例伴有肝脏血管分支的受压、推移、包绕或者闭塞改变。MSCTA所见与手术结果比较，对肝动脉（HA）评价的敏感度、特异度和阳性预测值分别为88％、96％和93％；对门静脉（PV）分别为95％、100％和95％；而对肝静脉（HV）分别为96％、86％和96％。结论MSCT能够全面地显示肝脏泡状棘球蚴病特征性图像和血管侵犯的状况，为正确的诊断和合理的治疗提供了可靠的影像学依据。     

Retropharyngeal space: evaluation of normal anatomy and diseases with CT and MR imaging

A retrospective analysis of computed tomographic (CT) and magnetic resonance (MR) images and clinical records of 39 patients with retropharyngeal space (RPS) lesions was completed. The review was undertaken to answer the following questions: (a) what is the spectrum of lesions of the RPS? (b) what imaging features mark a lesion as originating in the RPS? and (c) is there a difference between the radiologic pattern of the suprahyoid and infrahyoid portions of the neck? Of the 39 patients in the study, nine had RPS infections, 17 had RPS malignancies, two had benign tumors, seven had RPS pseudotumors, and four had hematoma or air in the RPS after trauma. RPS lesions demonstrated two distinct radiologic patterns: a nodal pattern and a nonnodal pattern. The nodal pattern, found only in the suprahyoid neck, occurs when infection or tumor begins in the lymph nodes of the RPS. The lesions may be unilateral or bilateral, but the middle part of the RPS is spared. The nonnodal pattern, found primarily in the infrahyoid RPS, results when the infection or tumor directly invades the RPS or goes beyond the nodes of the RPS. The nonnodal lesion appears rectangular and spans the RPS from side to side.     

肝泡状棘球蚴病的螺旋CT诊断

目的分析肝泡状棘球蚴包虫病(hepatic alveolar echinococcosis,HAE)的螺旋CT征象。方法21例经手术病理证实的HAE均行了螺旋CT扫描,其中15例行动态增强双期扫描。分析HAE的CT表现并与手术病理对照。结果21例共检出25个病灶,所有病例均表现为不均匀的低密度或混杂密度肿块影,形态不规则,平扫边界欠清,增强扫描后不强化,但边界显示清楚。所有病灶均伴有不同程度的钙化,15例有中心液化坏死,16例边缘出现小囊泡征。结论HAE的螺旋CT表现具有一定的特征性,能为诊断和临床治疗提供可靠的影像学依据。     

MSCT对肝泡状棘球蚴病的诊断价值

目的:分析肝泡状棘球蚴病(HAE)的MSCT影像学表现,探讨MSCT的诊断价值.方法:回顾性分析经手术病理证实的28例HAE患者的MSCT资料.28例均行MSCT平扫,其中16例行动态增强双期扫描.原始数据经过图像高级处理工作站行冠矢状面重建,分析HAE的MSCT表现并与手术病理对照.结果:28例共检出34个病灶,所有...     

Internal mammary artery embolization for hepatic tumors

Purpose To prospectively identify patients with collateral internal mammary artery (IMA) supply to hepatic tumors, and to embolize the IMA as part of palliative hepatic artery embolization (HAE). Methods Over a 4-year period, 222 patients were enrolled in an HAE protocol for inoperable liver tumors. All underwent abdominal computed tomography (CT) prior to preembolization diagnostic hepatic arteriography. When anterior subcapsular hepatic tumor was seen on the CT scan, patients underwent IMA arteriography as well. All arteries supplying tumor were embolized. Results Six patients had anterior subcapsular lesions identified on CT. IMA catheterization revealed that these lesions drew blood supply directly or indirectly from one or both IMAs in all six patients. All IMAs were embolized. Conclusion When an hepatic tumor is identified in an anterior subcapsular location prior to HAE, the IMA should be examined and, if significant tumor supply is demonstrated, these branches should be embolized.     

Hepatic alveolar echinococcosis: correlative US and CT study

A total of 24 cases of hepatic alveolar echinococcosis (HAE) due to Echinococcus multilocularis was assessed by US and CT. The diagnosis was confirmed in all cases by immunologic and histologic study. Both US and CT patterns of HAE showed changes of liver morphology in both contour and size. Abnormal areas of parenchyma were nodular or in fields, irregular, heterogeneous, and basically echogenic. On CT these lesions were hypodense (30 to 40 HU) and did not show enhancement after administration of intravenous contrast medium. Clustered microcalcifications were encountered within the abnormal parenchymal fields in 50% of cases, and necrotized zones occurred in 40% of cases. Dilatation of intrahepatic bile ducts was commonly seen, especially on US; hilar involvement was frequent. Follow-up by both techniques can display increases of primary lesions, occurrence of new foci, and local or regional extensions. Precise evaluation of the lesions arising from correlative use of US and CT permits adequate therapeutic management.     

肝脏泡球蚴病CT灌注成像与微血管密度及血管内皮生长因子的相关性分析

目的 分析肝脏泡球蚴病CT灌注成像与微血管密度(MVD)和血管内皮生长因子(VEGF)的相关性,评价CT灌注技术在显示肝泡球蚴血管生成方面的价值.方法 回顾性分析27例肝脏泡球蚴病患者的螺旋CT灌注检查资料,绘制病灶边缘ROI的时间密度曲线(TDC),并测定灌注参数包括血流量(BF)、血容量(BV)、平均通过时间(MTT)和表面通透性(PS).通过病理免疫组织化学方法测定病灶边缘区域MVD计数和VEGF的表达,对不同类型TDC的灌注参数、MVD和VEGF比较采用t检验,采用Spearman法分析不同类型TDC各CT灌注参数与MVD和VEGF表达的相关性.结果 21例为Ⅰ型TDC,6例为Ⅱ型TDC,两型TDC的BF分别为(111.7±27.6)和(158.9±39.5) ml· 100 g-1·min-1,BV分别为(15.1 +6.2)和(26.8±8.4) ml/100 g,MTT分别为(7.0±4.4)和(7.7±3.1)s,PS分别为(51.7±17.3)和(51.0±20.5) ml· 100 g-1·min-1,两型TDC之间BF、BV差异有统计学意义(t值分别为-7.897和- 18.783,P值均＜0.05),MTT及PS差异无统计学意义(t值分别为1.311和0.182,P值均＞0.05);两型之间MVD计数分别为(20.5±5.4)和(37.2±7.5)个/高倍视野,差异有统计学意义(t=-5.223,P＜0.05),而VEGF计分分别为(2.1±1.0)和(3.2±1.0)分,差异无统计学意义(t=-1.707,P＞0.05).MVD与Ⅱ型TDC的BF、BV有相关性(r值分别为0.789和0.878,P值均＜0.05),与MTT、PS间无相关性(P值均＞0.05);MVD与Ⅰ型TDC各参数之间,以及VEGF与两型TDC各灌注参数之间均无相关性(P值均＞0.05).结论 CT灌注成像不同TDC在一定程度上反映了病灶边缘不同的血管生成状态,有望为泡球蚴病灶边缘的血管化研究提供一种新的方法.     

Analysis of mediastinal lymphadenopathy in the right paratracheal area and the pretracheal retrocaval space by tomography with a compensating filter--diagnostic significance of mediastinal reflection

Findings of mediastinal reflection tomography with a compensating filter (Tomo) and its diagnostic significance for mediastinal lymphadenopathy were compared with those of computed tomography (CT) in 140 patients. The nodes were of normal size in 88 patients and enlarged (short transverse diameter on CT greater than or equal to 10 mm) in 52. With Tomo, the following findings had high sensitivity and a high positive predictive value (PPV): Irregularly widened (greater than or equal to 10 mm) right paratracheal stripe (RPS), irregular mediastinal reflection on the plane 1-2 cm in front of the plane of the trachea, bulge in configuration of the superior vena cava (SVC) exclusive of the area near the configuration of shadow thought to be the azygos arch (azygos arch), disappearance of the azygos arch, enlargement of the azygos arch, irregular margin of the upper-lateral portion of the azygos arch and increase in size of the more anterior part of the azygos arch, which is of homogeneous density. A high PPV but low sensitivity were noted for displacement or deformity of the trachea and/or the right main bronchus. High sensitivity but a low PPV were noted for disappearance of RPS and bulge in configuration of the SVC near the azygos arch. When the 7 findings with high sensitivity and a high PPV were combined, sensitivity, specificity and accuracy of Tomo were 84.6%, 96.6%, 92.1%, respectively.     

咽旁间隙肿瘤CT诊断

作者分析１８例经手术病理证实的咽旁间隙肿瘤的ＣＴ所见。将咽旁间隙分为茎突前间隙和茎突后间隙，根据解剖部位各异，其肿瘤的组织发生也不同，就该区域的解剖及病变所在表现，认为咽旁脂肪组织、血管、茎突的移位，变形和增强ＣＴ，对判定肿瘤的组织来源很有帮助。     

慢性硬膜下血肿术中引流管安置的临床研究

目的 探讨慢性硬膜下血肿（CSDH）钻孔引流术引流管头端安置的最佳位置，以降低血肿复发率。方法 分析130例CSDH患者术前硬膜下血肿宽度、中线移位程度、术后引流管头端不同部位（额、颞、顶、枕）、术后硬膜下腔的宽度、硬膜下腔积气与术后复发的关系。结果 CSDH术后复发与术前硬膜下血肿厚度及中线移位程度无关。术后7d硬膜下腔宽度≥1 cm或硬膜下腔积气超过硬膜下腔体积的20％者，复发率明显增高。术后闭式引流管头端置于额叶皮层处复发率最低。结论 闭 式引流管头端置于额叶皮层处可以通过排除颅内积气，达到减少术后血肿复发的目地。术后7d复查头颅CT，对预测术后复发概率大有裨益。